Basic Information
| Provider Information | |||||||||
| NPI: | 1285769018 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KANAAR | ||||||||
| FirstName: | RALPH | ||||||||
| MiddleName: | FENTON | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4969 E SHORE DR | ||||||||
| Address2: | |||||||||
| City: | ALGER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486109646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893455259 | ||||||||
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| Practice Location | |||||||||
| Address1: | 789 N CLARE AVE | ||||||||
| Address2: | |||||||||
| City: | HARRISON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486259194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9895392141 | ||||||||
| FaxNumber: | 9895392143 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801010053 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.